Abstract WP112: Predictors of 90-Day Recurrent Stroke in Patients with High-Grade Intracranial Atherosclerotic Stenosis: A subgroup analysis from the BIORISK-ICAS Study

Background: High-grade intracranial atherosclerosis (ICAS) is associated with an elevated risk of recurrent ischemic stroke, particularly in patients with severe stenosis (70–99%). Identifying predictors of early recurrence can inform risk stratification and guide treatment strategies. Methods: The Biomarkers and Recurrence Risk in Symptomatic Intracranial Arterial Stenosis (BIORISK-ICAS) study is a multicenter, international, retrospective cohort analysis pooling data from 35 comprehensive stroke centers. We included hospitalized adult patients with symptomatic ICAS, defined as 50–99% stenosis of an intracranial artery (intracranial vertebral, basilar, distal ICA, or M1 MCA), confirmed by vascular imaging and associated with a qualifying ischemic event. Patients with only high-grade stenosis (70-99%) were included in this analysis. The primary outcome was to determine predictors of recurrent ischemic stroke in the territory of the symptomatic artery within 90 days of the index event. Baseline demographic, clinical, and imaging characteristics were recorded. Multivariable Cox proportional hazards regression with stepwise selection (p < 0.1) was used to identify independent predictors of recurrence; model discrimination was assessed using Harrell’s C-statistics. Results: Among 2,050 patients, 1,476 had high-grade (70-99%) symptomatic ICAS. The mean age was 67 ± 12.5 years, and 767 (55%) were male. Most patients were non-Hispanic (90.1%), taking dual antiplatelet therapy (77.8%), and statins (94.5%). Recurrent stroke occurred in 160 patients (10.8%) within 90 days. In multivariable Cox model, independent predictors of recurrence included atrial fibrillation (HR 2.05; 95% CI, 1.26–3.33; p = 0.004), hyperlipidemia (HR 1.57; 95% CI, 1.10–2.24; p = 0.014), diabetes mellitus (HR 1.36; 95% CI, 0.98–1.88; p = 0.064), and home use of dual antiplatelet therapy (HR 1.60; 95% CI, 1.01–2.54; p = 0.043)(Harrell’s C-statistic=0.62). In patients who underwent perfusion(n=402), mistmatch >10seconds were associated with increased recurrence (HR 1.80; 95% CI 0.95-3.38, p=0.07) and atrial fibrillation (HR 2.06: 95% CI 0.03-4.60, p=0.78) though did not reach statistical significance. Conclusion: In this population, diabetes, hyperlipidemia, atrial fibrillation, and prior use of dual antiplatelet therapy were associated with increased risk of 90-day recurrent ischemic stroke. Perfusion imaging may help identify high-risk patients who could benefit from intensified secondary prevention.

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Journal
Stroke
Published
2026-01-29
DOI
https://doi.org/10.1161/str.57.suppl_1.wp112
Primary Topic
Cerebrovascular and Carotid Artery Diseases
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article

Abstract WP112: Predictors of 90-Day Recurrent Stroke in Patients with High-Grade Intracranial Atherosclerotic Stenosis: A subgroup analysis from the BIORISK-ICAS Study

William Almiri, James P. Klaas, Dalia Chahien, Nicole Marrone et al.
Stroke
Cerebrovascular and Carotid Artery Diseases
article

Abstract WP112: Predictors of 90-Day Recurrent Stroke in Patients with High-Grade Intracranial Atherosclerotic Stenosis: A subgroup analysis from the BIORISK-ICAS Study

William Almiri, James P. Klaas, Dalia Chahien, Nicole Marrone, Liqi Shu, Mohammad W Khasawneh, James Ernest Siegler, S Prabhakaran, Tarek El Halabi, Ajay Tunguturi, Shaista Alam, Kelly L. Sloane, Fahad Khan, Mirjam R. Heldner, Johanna Helenius, Hadley A. Walsh, D Liebeskind, Ahmad Abu Qdais, Skylar Lewis, Muhib Khan, Diana Aguiar de Sousa, Pooja Khatri, João André Sousa, Michele Romoli, Cheran Elangovan, Joao Pedro Marto, Mahasen Reda, Rami Morsi, Joao Freitas, Piers Klein, Aaron Rothstein, Sami Al Kasab, Osama Zaidat, Nils Henninger, Shadi Yaghi, rich baker, Chris Guerrero, Christoph Stretz, Argyro Tountopoulou, Yasmin Aziz, Adam de Havenon, Ayush Agarwal, Sridhara Yaddanapudi, Thanh Nguyen, Mohammad AlMajali
article en

Abstract

Background: High-grade intracranial atherosclerosis (ICAS) is associated with an elevated risk of recurrent ischemic stroke, particularly in patients with severe stenosis (70–99%). Identifying predictors of early recurrence can inform risk stratification and guide treatment strategies. Methods: The Biomarkers and Recurrence Risk in Symptomatic Intracranial Arterial Stenosis (BIORISK-ICAS) study is a multicenter, international, retrospective cohort analysis pooling data from 35 comprehensive stroke centers. We included hospitalized adult patients with symptomatic ICAS, defined as 50–99% stenosis of an intracranial artery (intracranial vertebral, basilar, distal ICA, or M1 MCA), confirmed by vascular imaging and associated with a qualifying ischemic event. Patients with only high-grade stenosis (70-99%) were included in this analysis. The primary outcome was to determine predictors of recurrent ischemic stroke in the territory of the symptomatic artery within 90 days of the index event. Baseline demographic, clinical, and imaging characteristics were recorded. Multivariable Cox proportional hazards regression with stepwise selection (p < 0.1) was used to identify independent predictors of recurrence; model discrimination was assessed using Harrell’s C-statistics. Results: Among 2,050 patients, 1,476 had high-grade (70-99%) symptomatic ICAS. The mean age was 67 ± 12.5 years, and 767 (55%) were male. Most patients were non-Hispanic (90.1%), taking dual antiplatelet therapy (77.8%), and statins (94.5%). Recurrent stroke occurred in 160 patients (10.8%) within 90 days. In multivariable Cox model, independent predictors of recurrence included atrial fibrillation (HR 2.05; 95% CI, 1.26–3.33; p = 0.004), hyperlipidemia (HR 1.57; 95% CI, 1.10–2.24; p = 0.014), diabetes mellitus (HR 1.36; 95% CI, 0.98–1.88; p = 0.064), and home use of dual antiplatelet therapy (HR 1.60; 95% CI, 1.01–2.54; p = 0.043)(Harrell’s C-statistic=0.62). In patients who underwent perfusion(n=402), mistmatch >10seconds were associated with increased recurrence (HR 1.80; 95% CI 0.95-3.38, p=0.07) and atrial fibrillation (HR 2.06: 95% CI 0.03-4.60, p=0.78) though did not reach statistical significance. Conclusion: In this population, diabetes, hyperlipidemia, atrial fibrillation, and prior use of dual antiplatelet therapy were associated with increased risk of 90-day recurrent ischemic stroke. Perfusion imaging may help identify high-risk patients who could benefit from intensified secondary prevention.

StrokeVol. 57(Suppl_1)
University of Maryland, Baltimore (US), Christiana Care Health System (US), All India Institute of Medical Sciences Raipur (IN), University of Minnesota (US), Brooklyn Hospital Center (US), Mayo Clinic (US), University of Arizona (US), University of Lisbon (PT), Royal College of Surgeons in Ireland (IE), Medical University of South Carolina (US), University of Tennessee Health Science Center (US), National and Kapodistrian University of Athens (GR), Chestnut Hill College (US), Washington University in St. Louis (US), Boston Micromachines (United States) (US), Brown University (US), Thomas Jefferson University Hospital (US), UCLA Health (US), Pine Manor College (US), University Hospital of Bern (CH), Hospital de São João (PT), Yale University (US), University of Chicago (US), Advocate Health Care (US), Unidade Local de Saúde de São José (PT), Hospital de Egas Moniz (PT), All India Institute of Medical Sciences Bhopal (IN), Ospedale “M. Bufalini” di Cesena (IT), Connecticut Health Foundation (US), Hackensack Meridian Health (US), Jefferson Hospital (US), UMass Memorial Medical Center (US), New York University Langone Orthopedic Hospital (US), Mercy Health (US), Hartford Financial Services (United States), University of Cincinnati (US), All India Institute of Medical Sciences (IN), University of Pennsylvania (US), Bogomolets National Medical University (UA)
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Openalex Percentile: Top 74%
Cerebrovascular and Carotid Artery Diseases
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